Hypovitaminosis C (scurvy)

Last revised by Mostafa Elfeky on 9 Dec 2022

Scurvy is a condition caused by a dietary lack of vitamin C (ascorbic acid), hence is also called hypovitaminosis C, and is characterized by an increased bleeding tendency and impaired collagen synthesis resulting in osteoporosis and impaired wound healing.

Scurvy in adults is rare. Young children and older persons are predisposed to scurvy due to their diet or the overheating of food. It does not occur before six months of age because maternal stores are maintained until then. Males and females are equally affected. Patients at risk include elderly males, alcoholics, smokers and those with malabsorptive diseases.

Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. bleeding gums, petechiae), and impaired wound healing.

Unlike most other animals, humans cannot produce their own vitamin C.

Lack of dietary vitamin C (ascorbic acid) may be related to inadequate food intake, the destruction of vitamin C in food caused by cooking and canning, or the absence of fresh fruit in the diet. 

Vitamin C is essential for collagen synthesis, acting as a coenzyme to producing cross-linking of collagen fibers. Defective collagen cross-linking compromises skin, joint, bone, and vascular integrity.

  • generalized osteopenia

  • cortical thinning: “pencil-point” cortex

  • periosteal reaction due to subperiosteal hemorrhage

  • scorbutic rosary: expansion of the costochondral junctions

    • may relate to the fracturing of the zone of provisional calcification during normal respiration

    • similar to the rachitic rosary appearance as seen in rickets

  • hemarthrosis

  • Wimberger ring sign: circular, opaque radiologic shadow surrounding epiphyseal centers of ossification, which may result from bleeding

  • Frankel line: dense zone of provisional calcification

  • Trümmerfeld zone: lucent metaphyseal band underlying Frankel line

  • Pelkin spur: metaphyseal spurs that result in cupping of the metaphysis

  • Pelkin fracture: metaphyseal corner fracture

Other significant manifestations in both children and adults arise from the propensity for bleeding, including intra-articular, retrobulbar, and intracranial hemorrhage.

The term scurvy comes from various words used to describe the manifestations of the condition: covered with scabs, diseased, scorbutic.

  • scheurbuik (Dutch)

  • scorbut (French)

  • skybjugr (Old Norse): a swelling (bjugr) from drinking sour milk (skyr) on long sea voyages

Infantile scurvy, historically also known as Barlow disease, is named after Sir Thomas Barlow (1845-1945), Professor of Medicine at University College London 1895-1907 5.

Eugen Fraenkel (1853-1925),  a German pathologist, was the first person to be appointed a full Professor of Pathology at the University of Hamburg in 1919 6,8.

Karl Francis Pelkan (1890-1992), an Austrian-American pediatrician described his eponymous spurs in a paper published in 1925 6,7.

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